Elizabeth W Blake and Julie M Sease

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OBJECTIVE: To evaluate the effect of diabetes medications on the risk of cardiovascular disease and surrogate markers.

DATA SOURCES: Literature was accessed through MEDLINE (1950–July 2008) and PubMed using multiple terms for diabetes, cardiovascular risk, surrogate markers, and diabetes medications. In addition, reference citations from publications were reviewed.

Study Selection and Data Extraction: English-language articles that met the above criteria, with clinical relevance, were evaluated.

Data Synthesis: Evidence regarding the effect of diabetes medications on cardiovascular risk is sparse, with information on their effects on surrogate markers more widely available. Recent evidence demonstrates that glycemic control alone may not reduce the risk of macrovascular events. Multiple trials were reviewed to determine the effect of diabetes medications on this risk, as well as the effect on surrogate markers (eg, blood pressure, cholesterol, body weight). Metformin and acarbose demonstrated significant reductions in macrovascular events, including myocardial infarction. Data regarding sulfonylureas, thiazolidinediones, and insulin are conflicting. Pioglitazone may reduce cardiovascular events, except heart failure, whereas rosiglitazone may increase these events. Until direct evidence can be obtained, the full effect of diabetes medications on cardiovascular risk is unknown.

CONCLUSIONS: Current literature provides little support that diabetes medications may lower the risk of cardiovascular events while some agents may increase this risk. Of the drugs available, metformin may be the least detrimental. Current literature regarding other diabetes medications provides conflicting results on their effect on cardiovascular outcomes. In the meantime, practitioners should treat all targets of cardiovascular risk in patients with diabetes.

J Pharm Technol 2009;25:24-36
ACPE Universal Program Number: 407-000-09-050-H01-P (Pharmacists); 407-000-09-050-H01-T (Technicians)